Concierge or retainer medicine – considering the why?

Patients want continuity, comprehensiveness, and access. None of my golf buddies are physicians. They want access at their convenience. Often they’ll call me in the morning and want a problem addressed that day. I try to help them, when I can, but the current system generally lacks that responsiveness. Last year my 25 year old daughter called me on a Sunday night complaining of an acute illness. I was fairly certain that she had influenza and would benefit from medication. I told her to call her internist the next morning to either get a prescription called in or be seen. Her internist’s office said she couldn’t be seen until Tuesday. My understanding of the anti-influenza medications says that those 24 hours were very important – she remained ill for approximately a week.

Patients want time with their physician. One physician that works in my division has a great clinical reputation. Her patients commonly tell me that she spends enough time with them and ‘really listens’. Unfortunately, you don’t often hear physicians described like that.

I remain fascinated with retainer medicine.  A search in this blog will find many articles related to retainer medicine.

This week in thinking about retainer medicine I had a minor inspiration.   The patient centered medical home (PCMH) model has much in common with retainer medicine.

Many physicians speak against retainer medicine.  These physicians object to the financial model.  I urge them to get past the money and consider why patients are willing to pay for retainer practices.  Patients want access.  They want appointments at their convenience; they want phone access; they want email access.  They want the physician to spend enough time with them and thinking about them.

Our current model rarely provides any of those things.  We need a new model, and perhaps understanding the success of the retainer model would inform true reform.